BOULOS DENTAL CARE, P.C.
NPI: 1023308392
· SHOREVIEW, MN 55126
· Exclusive Provider Organization
· NPI assigned 04/07/2011
$112K
Total Medicaid Paid
Provider Details
| Authorized Official | BOULOS, SAMY (DENTIST (DDS)) |
| NPI Enumeration Date | 04/07/2011 |
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2019 |
67 |
$3K |
| 2020 |
591 |
$21K |
| 2021 |
809 |
$28K |
| 2022 |
456 |
$23K |
| 2023 |
399 |
$20K |
| 2024 |
370 |
$18K |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
998 |
991 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
1,062 |
1,054 |
$33K |
| D0274 |
Bitewings - four radiographic images |
530 |
527 |
$20K |
| D1206 |
Topical application of fluoride varnish |
72 |
70 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
30 |
30 |
$366.48 |